{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:38:52Z","timestamp":1776818332743,"version":"3.51.2"},"reference-count":9,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,12,7]]},"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:p>A woman in her 40s presented to the emergency department with epistaxis. Anterior nasal packing was unsuccessful in achieving haemostasis. After the exchange of devices and insertion of a posterior nasal pack, the patient developed a junctional rhythm and progressively unstable bradycardia. The rhythm and bradycardia immediately improved following the removal of the posterior nasal pack. This case describes a rare occurrence of Trigeminocardiac reflex (TCR), following an insertion of a posterior nasal pack. Only one other such case has been reported and published. This case highlights the importance of raising awareness of this rare reflex and the need for prompt removal of the triggering cause in such scenarios. TCR can induce a junctional rhythm, which progresses to unstable bradycardia and may lead to asystole in susceptible individuals. The removal of the stimulus resolves the reflex and can result in prompt resolution of the bradycardia and hypotension induced via the TCR.<\/jats:p>","DOI":"10.1136\/bcr-2023-258537","type":"journal-article","created":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T12:40:22Z","timestamp":1702989622000},"page":"e258537","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Unstable bradycardia induced by posterior nasal packing: a rare activation of the Trigeminocardiacreflex"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8343-5271","authenticated-orcid":false,"given":"Carl","family":"Byrne","sequence":"first","affiliation":[{"name":"James Connolly Hospital Emergency Department, Blanchardstown, HSE, Dublin, Ireland"},{"name":"University College Dublin, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Flynn","sequence":"additional","affiliation":[{"name":"University College Dublin, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carthage","family":"Carroll","sequence":"additional","affiliation":[{"name":"James Connolly Hospital Emergency Department, Blanchardstown, HSE, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,12,19]]},"reference":[{"key":"2025082702522372000_16.12.e258537.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2004.12.014"},{"key":"2025082702522372000_16.12.e258537.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(95)70169-9"},{"key":"2025082702522372000_16.12.e258537.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp0807078"},{"key":"2025082702522372000_16.12.e258537.4","first-page":"147","volume-title":"Sber Akad Wiss Wien","volume":"62","author":"Kratschmer","year":"1870"},{"key":"2025082702522372000_16.12.e258537.5","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1999.90.2.0215"},{"key":"2025082702522372000_16.12.e258537.6","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000000484","article-title":"Trigeminal cardiac reflex: new thinking model about the definition based on a literature review","volume":"94","author":"Meuwly","year":"2015","journal-title":"Medicine (Baltimore)"},{"key":"2025082702522372000_16.12.e258537.7","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2017.00533","article-title":"Definition and diagnosis of the trigeminocardiac reflex: a grounded theory approach for an update","volume":"8","author":"Meuwly","year":"2017","journal-title":"Front Neurol"},{"key":"2025082702522372000_16.12.e258537.8","first-page":"45","article-title":"Epistaxis and death by the trigeminocardiac reflex: a cautionary report","volume":"32","author":"Awasthi","year":"2015","journal-title":"Fed Pract"},{"key":"2025082702522372000_16.12.e258537.9","doi-asserted-by":"crossref","DOI":"10.1186\/1752-1947-4-391","article-title":"A new predisposing factor for trigemino-cardiac reflex during subdural empyema drainage: a case report","volume":"4","author":"Spiriev","year":"2010","journal-title":"J Med Case Rep"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-258537","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T09:52:34Z","timestamp":1756288354000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-258537"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12]]},"references-count":9,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12,19]]},"published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1136\/bcr-2023-258537"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-258537","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12]]}}}